Boarding Policy & Intake Form

Your Name*

First NameLast Name

Cell Phone Number*

Area CodePhone Number

Second Phone number*

Area CodePhone Number

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

What is you pet's NAME*

What day will you be dropping off your pet? (We are closed on Sundays and Holidays)*

Date

What day will you be picking up your pet? (We are closed on Sundays and Holidays)*

Date

What time will you pick your pet up? (Boarding check out time is 12pm)*

I understand that if my pet is not picked up by 12pm, I will be charged an additional day of boarding. *

INITIALS REQUIRED

Have you, someone in your home or your pet experienced respiratory symptoms (coughing, sneezing, wheezing or fever) in the last 14 days?

YesNo

Who is experiencing these symptoms? *

This petAnother petA humanMultiple Humans

Have you or your pet been exposed to anyone diagnosed with Covid, showing signs of Covid or has a pending Covid test in the last 14 days?

YesNo

Have you or someone in your home been asked by a health care professional and/or the Department of Health/CDC to quarantine in the last 14 days?

YesNo

GENERAL BOARDING POLICIES

BORDETELLA INORMATION (Canines)

Dogs that board anywhere may contact an upper respiratory virus. If your pet should contract a virus while boarding, you will not be charged an office visit charge when treated, but you will be charged for any medication associated with treating this cough.

I have read and understand the information stated above regarding bordetella. *

INITIALS

HURRICANE PREPARATION

In the event of a hurricane, all pet owners boarding their animals must arrange for their pet(s) to be picked up at least 24 hours before the anticipated landfall of a storm. The doctors and staff of Gause Boulevard Veterinary Hospital do evacuate with their families in the event of a hurricane, and therefore we cannot be responsible for your pets and their welfare if they remain in our facility.

I have read and understand the information stated regarding the hurricane policy. *

INITIALS

Name and phone number of the person responsible for picking up your pet(s) IN THE EVENT OF A HURRICANE (LOCAL CONTACT IF YOU ARE UNABLE TO DO SO)*

Full Namephone number

OWNER RESPONSIBILITY

I have been advised that if I neglect to pick up my pet(s) within 5 days of the scheduled pick up date, unless alternate arrangements are made, GBVH may assume that the pet is abandoned and is hereby authorized to do what they deem necessary. This may include, but is not limited to, treatment, rehoming, or other decisions that are in the best interest of the pet.

I have read and understand the information stated regarding the owner responsibility.*

INITIALS

PERSONAL PROPERTY

It is out general policy not to accept blankets, beds, or toys for the pets staying with us. We will make every effort to make the dog comfortable and provide some play time during walks. If the owner chooses to leave any personal belongings with the pet other than food, GBVH will not be responsible for any damage or loss of the items that may occur. We strongly recommend that the owner keep those items in their possession.

I have read and understand the information stated regarding personal property.*

INITIALS

VACCINATION POLICY

It is our policy that all pets must be current on vaccinations to board. It is best to have vaccines at least 7 days prior to boarding, otherwise vaccines may not provide the coverage needed to keep your pet safe. If you pet's vaccines are not up to date, our veterinarians will administer vaccines upon intake and you will be responsible for the cost of the vaccinations as well as an examination by our veterinarian.

I have read and understand the information stated regarding the vaccination policy.*

INITIALS

FLEA PREVENTION POLICY

ALL PETS WILL RECEIVE A CAPSTAR OR ADVANTUS ($6.50) flea pill to ensure that no fleas are introduced to our hospital or boarding facility. There are NO exceptions. This is a 24 hour flea pill and is NOT prevention, nor will it interfere if your pet is on prevention. This is a standard of care that is to protect your pet, and all pets staying at our facility.

I have read and understand the information stated regarding the flea prevention policy*

INITIALS

Pet Name*

Does your pet any medical concerns you would like addressed while boarding?*

No thank youYes

Please describe your concern, including how long it has been going on, how it started, has it improved/gotten worse since the onset.

Does your pet have any ongoing medical conditions that we should know about while boarding?*

NoYes

Please describe the medical condition, including any medications that your pet has been prescribed for the condition.

Will your pet need medications while boarding?*

YesNo

What Medications - How much - How often*

NOTE: Nursing Care charges of $4.25 per medication per administration will be incurred for the administration of medications. *

INITIALS

What will your pet be eating our kennel food while boarding:*

YesNo, we are brought our own food

When does your pet typically get fed?*

1 x per day - morning only1 x per day - evening only2x per day - morning and evening

What is the brand and name of the food if bringing your own?

How much is your pet fed at each meal? *

Additional feeding instructions:

Did you bring treats to be given for your pet?*

yesno

What are the instructions for the treats (how much, how often?)

Please note: treats given outside of normal feeding schedule (morning / evening) may be charged a nursing care fee.

Is there anything you think we should know about your pets while they are boarding with us?

Would you like your pet to receive any of the following while boarding

Nail TrimBathDental (requires anesthesia - ask for price)

Would you like to receive text photos of your pet while boarding? WE CANNOT GUARANTEE PICTURES FREQUENTLY BUT WILL DO OUR BEST TO ACCOMMODATE. It depends on our staff availabilty and free time.

YesNo, thank you

UNFORSEEN ILLNESS - In the event your pet gets ill while boarding and we are unable to reach you, please let us know your preference (CHOOSE ONE):*

I authorize my pet to be treated for anything the vet deems appropriate and understand I will be responsible for the charges incurred.I authorize my pet to ONLY be treated for life threatening disorders.

EXTRA PLAY TIME: If you think your pet will be bored while separated from you, we offer optional playtimes with special attention (brushing, extra walks, playing, petting, etc.) at the cost of $2.50 per playtime session. Please indicate the number of additional play times you would like your pet to receive each day: (We will do our best to accommodate your request, but will only charge for the times we are actually able to provide extra time based on staff availability.)

noneonce a daytwice a day

Signature*

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